Who is responsible for resurging Covid-19 cases? How is black marketing of vaccination taking place? Top doctors and health experts—Dr Ishwar Gilada, consultant in HIV and infectious diseases, secretary-general of People’s Organisation and The Organised Medicine Academic Guild of India, Dr Anjan Trikha, chairman of Clinical Managerial Group Covid sector at AIIMS, Dr Dhiren Gupta, senior consultant and paediatrician at Sir Ganga Ram Hospital—answer all this and more.
Q. Who is responsible for the explosive second Covid-19 wave?
Dr Trikha: You, me and the citizens of the country are responsible for this surge. A lot of people seem sick and tired of it and have taken things for granted and just don’t realise its implication. Although the side effects or the gravity of the disease is less compared to the last time, the numbers are increasing, ICUs are getting full. There’s no bed available in Maharashtra, Pune is a standing example, Nagpur is another example, and Delhi is not far off. People have to realise that we might have to come back to the same level of precautions that were there last April or May and then only we can beat it. The positive thing is that more and more people are getting vaccinated we presume that will lead to some kind of immunity amongst them but people have to keep taking precautions.
Q. Why have people taken norms and guidelines for granted?
Dr Gilada: I think our people didn’t expect the second or third wave to come. If you have seen a second or the third wave anywhere in the world, the second wave was stronger than the first wave and the third wave is always stronger than the first and second wave put together. So, we are going to also have a third wave, we are not going to stop at the second wave only. A good thing about the second wave is that it is a highly infectious virus but less lethal.
This time, people are not thronging the hospitals so only those who require hospitalisation are going to the hospitals and therefore doctors can concentrate on them. Otherwise, earlier as soon as people were getting tested positive, they would lock the beds in hospitals so there was a lot of shortage of beds at that time.
About 15 days back Maharashtra was reporting 70% cases; currently, it is reporting 58% cases that means a 12% gap is taken by other states. What happens is, in Maharashtra, the cases are increasing at 10% every day or every two days there are 4,000 to 5,000 cases. Around 15 days back, there were only 44 cases in a day in Bihar and Uttar Pradesh was reporting 126 cases in a day. Now cases in UP have gone up 10 times and cases in Bihar have gone up 8 times in just two weeks. So, it doesn’t take much time for the small numbers to become big numbers.
Look at the people who are masking, they are not covering their nose or mouth, if they want to talk they take off the mask. We need to change the attitude of the people. Most importantly we have always been blaming young people saying that young people are responsible for carrying the infection from society to home, home to society but if only blame game is there we are not going to solve the problem. I have worked in HIV for 35 years and know that blaming young people was a wrong strategy. Set a centre stage of programming, prioritising them is the strategy so now also we need to prioritise the young population all over. Programmes should be young people-centric and make them responsible for their own generation, the next generation and the senior generation. If they will be responsible only then we can control the pandemic.
Last but not least, the vaccine is to prevent the third surge, not the second surge. We cannot prevent the second surge through vaccination.
Dr Gupta: I’m a clinician, though I’m a paediatrician, last year I managed around 2,000 plus adult patients online and I am taking care of the adult ward now. In the past six days, I have gotten a lot of adult Covid calls especially doctors who usually call me to get treated by me as I am an infectious disease expert. Our pace of vaccination is very slow, at this time last year our 30% of staff got infected including our fellows, resident doctors, nurses so 30% of the beds were occupied by our staff. Now, at present none of those people who got infected and later got vaccinated and have probably been exposed to the virus. But even if they are infected, they are not spreaders or super spreaders. As per my experience over the past 15 days in Delhi, probably hospitals seem safer as everybody is vaccinated as compared to last year when hospitals became the hub.
I found that the PGI dean got infected despite two vaccination doses. Let’s be responsible, not only as a citizen but as a scientific person, a doctor, and as a community person. People think that they are young and won’t get affected so they are taking the disease too lightly and are spreading it. They’re not concerned about Covid appropriate behaviour. Also, they think vaccination is meant for them. Recently, our Health Minister has said that we need not vaccinate everybody in due course of time but I think we need to vaccinate everybody in due course of time.
Q. Do you think that if we vaccinate children, then it will become easy to get herd immunity?
Dr Gupta: Children may not get a severe disease but they are spreaders and what I found, as I closely monitor the families and paediatric patients, grandparents are very closely attached to their grandchildren. So, we need to vaccinate all populations and that should be the strategy probably.
As for vaccination, my feeling is very clear. Firstly, we should pitch in all the doctors whether they are MBBS, MD or final-year students. Doctors should pitch in to vaccinate in their respective clinics and we should not be rationed, rationing should not be there that only you can charge Rs 50 only, you can charge Rs 100. Let it be open.
Q. Do you think mass vaccination is a solution?
Dr Trikha: I feel that looking at the number of people and their general behaviour in the society, how much we respect our loss, how much we respect the basic hygiene of our city, considering all these it is going to be a very tough call. I sincerely think we do a good job if people do not overcrowd places. Vaccination is not the only issue the government has to think about, they have to think about elections and after the election results, you will see what will happen. The issue of vaccinating children was brought up but children cannot get vaccinated as there is no data to support that the vaccine has been used on children in the trials. Only two studies have been started in the US where they are taking care of children between 14 to 17 because as per international definitions you can have a 17-year-old vaccinated and he comes into the subgroup of a child. Unless you have data, you don’t know what will happen and we need not start vaccinating children unless we think that it is pretty safe. Vaccination has to be voluntary. We have to be persistent about vaccination and I’m sure things are improving. Vaccinating children is still a far-off thing. There was a lot of controversy regarding pregnant women that is settling down. Mass vaccination doesn’t seem like a viable solution
Q. Are we getting reinfection cases also because there are a lot of covid patients?
Dr Gilada: Whether you get infected and develop antibodies or whether you take the vaccine and develop antibodies, the antibodies will last a maximum of six to eight months or maybe 10 months and that is very important even from the vaccination point of view. If the vaccination effect is going to last only for eight to ten months that means whatever number of people we need to vaccinate that entire thing has to be completed in eight to ten months. We have only six to seven months whatever targeted people are there may be 60,00,00,000 70,00,00,000 at two doses that is 1, 20,00,00,000 process has to be finished within six to eight months and if it is not done then all of second round of the vaccine has to be repeated. Similarly, those who were infected six to eight months back are getting reinfected and that is also possible currently. There are new variants and strains, there are people who are fully vaccinated and despite that, they are getting infected. You should know that the vaccination will not work on 30 to 40% of people, so despite getting vaccinated that person will still get infected and there cannot be news on that but because of social media and electronic media such news are spread and therefore people are not taking the vaccine.
The most important thing is also to wrap up the vaccination. We need 24×7 vaccination, we should have the vaccination at private and public hospitals, at mobile clinics, and at workplaces. Initially, we did not understand whether the vaccine will give a lot of severe reactions or not therefore we were asking people to wait for half an hour to prevent overcrowding in that waiting area. People who are just vaccinated can get infected from next door people so we need to change all those things in light of currently available experience which is approved as an emergency authorisation. Black marketing is happening in terms of vaccination as people are showing false comorbidity certificates to get vaccinated. Some vaccination centres are even keeping a doctor there who is giving false comorbidity certificates. How do you confirm the documentation? You cannot see comorbidity; anybody could say they’ve it. No certification can be authentic.